زكاة العلم الدكتور محمد البيضاني

Old age male with history of IHD presented with palpitations ECG show sinus rhythm with frequent ventricular ectopic beats monomorphic type and appear couplet at some area ( double ventricular ectopic beats) .

Old age with history of IHD, heart failure and atrial fibrillation. Recently on routine follow up she note that bood urea start to elevate and reach 90 mg/dl . Anyhow He take digoxin daily . Nowadays she develop bradycardia, nause , vomiting and slight confusional state. ECG SHOW - regular R—R interval - narrow QRS - obvious fibrillation ease without P wave Conclusion: the patient develop complete heart block with junctional escape rhythm due to digoxin toxicity Note : regularisation of AF with fibrillation wave and patient on digoxin treatment is digoxin toxicity until prove otherwise.

45 years old female presented with sudden onset of SOB. He had negative history of IHD,no structural heart disease, no history of fever, no history of pregnancy and so on. He just had tenderness in the right legs Spo2 :92% HR:140 bpm BP:100:65 mmHg ECG show - sinus tachycardia - slightly right axis deviation ( negative R in avL and positive in lead II) - slightly S1Q3 and flat T wave in lead III - partial RBBB - persistent deep S in V6 All of these are strains pattern over the right side Echo study show - dilation Right side - slightly fluttering in the intraventricular septa - D shape in the left ventricular in the short axis - tricuspid regurgitation with pulmonary pressure about 49mmHg. Pressure overload. D dimer elevated CT angiography show pulmonary embolism Patient take actilyase (200 mg over 2 hour) there is improvement - decreased the dyspnea - decreased the heart rate to 105 bpm - improved BP - also echo study show decrease the pressure overload over the right side ونسالكم الدعاء

Bradycardia – tachycardia syndrome •Alternating bradycardia with paroxysmal tachycardia, often supraventricular in origin. •On cessation of tachyarrhythmia may be a period of delayed sinus recovery e.g. sinus pause or exit block. •If significant this period of delayed recovery may result in syncope. >> sick sinus syndrome

Cocaine : Is the most commonly used illicit drug among patients presenting to emergency departments, and associated cardiovascular consequences include - ischemia and infarction, myocardial diastolic and/or systolic dysfunction - arrhythmias. The mechanisms of myocardial ischemia and infarction include (1) increased myocardial oxygen demand in the setting of limited oxygen supply. (2) intense coronary arterial vasoconstriction, and/or enhanced platelet aggregation and thrombogenicity. (3) In addition, the vascular injury caused by cocaine may lead to increased endothelial permeability and accelerated atherogenesis. Notes : 1- Cocaine use increases the risk of myocardial infarction (MI) 24-fold over the following 60 minutes in individuals otherwise at low risk for MI. 2- the occurrence of myocardial infarction after cocaine is not associated with the amount ingested, route of administration, or frequency of use. 3- Mechanisms of myocardial dysfunction after long-term cocaine use include (1) myocardial ischemia or infarction, (2) cardiomyopathy due to repeated sympathetic stimula-tion, and (3) altered myocardial and endothelial cytokine production. 4- also myocardial dysfunction can also occur acutely after cocaine use, likely reflecting drug-associated metabolic disturbances or direct toxic effects of the drug.

Inferior MI with complete heart block

عقد الطباعه تم مع مكتب زوين للطباعه والنشر / النجف الأشرف. تم تصميم الكتاب وترتيبه وتم تصميم الغلاف وسيكون متوفر في دار النشر بفتره اقل من اسبوع ان شاءلله

40 years old female presented with SOB, chest pain with sweating , confusion, restlessness and palpitations. During examination there is - tachycardia - tachypnea - bilateral good air entry - muffled heart sound - rise JVP - hypotension ECG show - tachycardia - slightly low voltage ECG - electrical alternans ( change in the hight of QRS) Echo study show - pericardial collection - diastolic collapse of right side History, examination, ECG and echo study pass with cardiac tamponade. The patient was passed before intervention. Notes: - pericardial space contain less than 50 mL of pericardial fluid - more than 50 mL is pericardial effusion - acute heart failure due to pericardial collection is cardiac tamponade - tamponade occurs regardless the amount as rapid collection of small amounts can causes tamponade. - avoid diuretics and give IV NS and prepare for pericardiocentecesis as some as possible.

Heart failure,renal failure on dialysis Dyspenic ,pitting odema, chest crepitation, BP12/80 1 sinus tachycardia 2 Low voltage ECG R wave less than one large sequar in limb lead and less than two large sequar in pericardial lead 3 electrical alternas ( change in the hight of QRS or change in the deflection ) >>>>Pericardial effusion

تخطيط بدون هستري

This ecg of patient presented with agitation, paler , sweating, cold extremity, Disturbance level of consciousness And had chest pain for one day duration ECG show Complete heart block due ischemia ( ST elevation in inferior leads and pericardial lead) Look to the atrioventricular dissociation ( atrial rate about 100 and ventricular rate 46 , each time one work separately) The ventricular take rhythm from perinodal area ( junctional escape rhythm regular,narrow, and rate 40–60 bpm) The patient died unfortunately, She was just sever hypotension and low cardiac systolic function. My message heart block with anteriosptal Ischmic bad prognosis because the necrosis reach to AV node While in those with inferior MI Get better as the block due to decrease blood supply to the AV node Which improve after reperfusion

24 years old female from Al Majar Al Kabeer city/ Maysan / Iraq with negative history of neurological disease or any other disease . Anyhow he presented with generalised weakness and can’t weak and this attack occur after heavy sweat diet. Vital signs was normal ECG was done And I sent for S electrolytes. Discuss the relationship between the sweat diet ,the weakness and the ECG findings? #ببساطة Answer - Presentation generalised weakness - precipitated by sweet diet ( as the insulin shift the glucose to the cell the potassium enter with it “ the body already potassium depleted) that’s why we use insulin and glucose in the treatment of hyperkalemia - ECG finding 1- widespread st depression 2- flattening and T wave inversion 3- prominent U wave 4- prolonged QT Treatment : potassium replacement In the case we need IV infusion And the preferable fluid is Manitol 20%😁!

56 years old male presented with intracranial haemorrhage That manifested by T wave inversion in the ECG. Other ECG findings - sinus bradycardia or junctional rhythm - prolonged QT - widespread ST depression or elevation.

56 years old female with history of IHD,HF and hypertension presented with palpitations and hypotension ? ECG show ventricular tachycardia which is unstable treated by 100 J synchronised DC . ECG after shock reveal sinus rhythm with ventricular ectopic beats which is the focus that form the VT.

22 years old female with history of operation before 4 days presented with sudden onset dyspnea, chest pain , pale , sweaty , agitation , cyanosed and feverish . Chest auscultation revel good air entry No chest crepitation BP: 90/60 mmHg Spo2:82 HR: 120bpm ECG was done ECG show 1- sinus tachycardia 2- right axis deviation (avL negative and lead III positive) 3- S1Q3T3 4- T wave inversion in inferior and right pericardial lead With history and examination and ECG findings this is massive pulmonary embolism ( T wave inversion in inferior and V1,2,3 ) indicate severity of Pulmonary embolism. CTAG confirm the diagnosis ( this case need actilyase without CTAG as the there is risk factor which is operation , clinical features, vital signs indicate unstablility , ECG , no other explanation of condition “ dyspnea with normal chest examination is PE Until prove otherwise) AS you may loss the patient while waiting CTAG other ECG finding - RBBB - poor progression of R wave - new arrhythmia like AF -……

Atrial fibrillation with old anterior MI(poor progression of R wave in anterior pericardial lead and widening of QRS give picture of LBBB) and couplet ventricle ectopic beat

SVT after modified Valsalva manuver

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